title: Trends in revision circumcision at pediatric hospitals.
abstract: BACKGROUND
  We sought to determine the incidence of revision circumcision at freestanding children's hospitals, and examine trends over time.
  
  
  METHODS
  We searched the Pediatric Health Information Systems database to identify boys undergoing revision circumcision (RC), primary non-newborn circumcision (PC), or lysis of penile adhesions (LPA) from 2004 to 2009. Rates of RC procedures were calculated by dividing the incidence of procedures by the total male ambulatory surgical volume.
  
  
  RESULTS
  We identified 34,568 patients of whom 5632 underwent RC, 25,768 PC, and 3168 LPA. The rate of RC increased 119%, which was significantly more than PC (19%; P<.001) or LPA (37%; P<.001). Urologists performed 76% of RC and 12% were performed with other genitourinary procedures. Boys undergoing RC were predominately white (60%) and publicly insured (61%).
  
  
  CONCLUSIONS
  There was a disproportionate increased rate of RC performed at Pediatric Health Information Systems hospitals compared with PC or LPA. Wide variation exists in rate increases among hospitals.
authors.affiliation: Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kokorowski
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.forename: Katherine
authors.initials: K
authors.lastname: Hubert
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects / Q000639:trends*; D016208:Databases, Factual; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016012:Poisson Distribution; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D014945:Wound Healing / Q000502:physiology
keywords: circumcision; pediatrics; penile adhesion; variation